Technical Field
The present disclosure relates to an occipital fixation assembly, system and method for attaching the same. More particularly, the present disclosure relates to an occipital fixation assembly that is configured to support a surgical implant thereon and securely anchor to an inside of a skull of a patient.
Description of Related Art
As is commonly known in the art, an occipitocervical junction includes an occiput, atlas and axis. The occipitocervical junction is a unique interface between the cranium and cervical spine. More than 50% of the rotation and flexion-extension are provided from this region. Ligaments in this region must resist forces about all six degrees of freedom. Moreover, instrumentation constructs not only must resist forces in all of these vectors, but also must resist the significant moment created by the suboccipital bone and the cervical spine, which meet at a 50° angle. Any instrumentation construct designed for use in this region must, therefore, have adequate geometry to interface with the osseous structures of the spinal structures as well as have sufficient rigidity and purchase to resist these forces until bone fusion can occur.
At one time, occipitocervical instability and lesions located at the occipitocervical junction were considered inoperable and terminal. Since the first description of an occipitocervical fusion, multiple methods of fusion in this region have been described. Descriptions of simple bone grafts with halo immobilization; wire, pin, or hook constructs; rigid metallic loops and rectangles fixed to the bone with either screws or wires; and most recently, plate or rod constructs with screws have all been described. In general the evolution of this technology has focused on providing increasingly more rigid constructs to facilitate bone fusion and to minimize the need for and duration of external immobilization.
A common technique for fixing occipitocervical instability is the use of an inverted Y-shaped screw plate. Using this technique, the plate is secured to C1-2 with transarticular screws and to the suboccipital bone with paramedian screws; the suboccipital bone varies in thickness, with a mean thickness of 14 mm. Screws must be carefully selected to provide adequate purchase, yet avoid cerebella injury. Utilizing the maximum screw length possible is critical because shorter screws have decreased resistance to pullout. If stabilization is required below the C1-2 level, then lateral mass screws can be placed through additional holes in a longer plate to include these levels as well. In certain instances, a bone graft may be added to promote fusion. The Y-shaped plate, in combination with transarticular screws, is an economical alternative. Immediate postoperative stabilization is achieved and very low rates of pseudarthrosis have been reported. Due to the risk of selecting the correct screw size and the potential for cerebellar injury along with the potential for screw pull-out due to the short nature of the screw lengths allowed for use, it may prove advantageous to provide an occipital fixation assembly, and a system and method for attaching the same that can reduce the chance for pull-out and reduce the risk for cerebellar injury.